Thoughts on hospital sites [microform]

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PREFATORY NOTE.

The following letters and editorial, first published in
the Montreal Gazette, have been reprinted by request of
friends of the union of the Montreal General and Royal
Victoria Hospitals, and are respectfully commended to
the favorable consideration of those interested in either
or both of those institutions, and in the great public
objects which they are intended to serve.

Copies have been placed in the hands of gentlemen

connected with both hospitals.
Sept., 1889.

THOUGHTS ON HOSPITAL SITES.

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(From Correspondence and Editorial of Montreal Gazette, July and Aug., 1889.)

Tax New Hospirtat SITE.
To the Editor of Tut GAZETTE :

Sir,—Those who watch the discussion of public affairs from
the standpoint of the ordinary citizen, who, while deeply
interested, has no determining voice (except that of an occasional
vote at a civic election), have been sometimes amused, sometimes
grieved, in noticing the varied and discordant opinions of “‘ ex-
perts” and “‘ non-experts ” on the above matter, so seriously
concerning the most vital interests of the community.

One thing that strikes the average citizen, if at all an observant
man, is the familiar fact that in the St. Lawrence valley, and es-
pocially in our cities, a very little elevation on any hillside secures
an appreciable improvement of atmosphere as compared with
that in the lower grounds, where the air is moist and warm in
summer and loaded with noxious effluvia. In the lower part of
the town one can scarcely open a window in the warm weather
without being disagreeably reminded that the atmosphere is flat
and destitute of ozone, besides being none of the purest. But if
I can spare an hour to ascend the slope uf Mount Royal, or to
stroll in the Mountain park, I find a fresh and invigorating
atmosph**e—as much 80 as if I had gone a hundred miles into
the country. I return feeling myself for the time a new man. If
I were sick I would rather lie in a shanty on the mountain than
occupy a palace in the lower part of the town, Some day, when

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intelligence has advanced a little, there will be a sanitarium on
the top of the mountain to which mothers _may send ther
children, and where fresh air, pure water, and suitable food
would remove their little summer ailments as effectually as a more
expensive ar: troublesome journey to the country, and whence
they may return to their homes instead of being carted off to the
cemetery, where we provide over their little graves the moun-
tain air and foliage that might, if administered in time, have
helped to keep them alive, In the meantime our wealthy citizens
appear to know this, and perch their handsome residences on the
mountain. I can fancy that some of them, after enjoying s:1ch
pure air, must appreciate the difference when they go down to
the General Hospital to vote for keeping the poor man in his
sickness in the warmest and most crowded part of Dorchester
street, and out of the reach of the fresh breezes that would double
his chances of recovery, .

In view of all this, two liberal and large-hearted men have
been found who have purchased one of the finest sites on the
mountain—a much better site than either of them possesses for
his own house, and have broken ground for the erection of a noble
structure overlooking the city and away from its noxious exhala-
tions, where the poor man may be tended in his sickness, and in-
stead of pining amidst insalubrious surroundings may have all
the advantages which the rich can command, The distance is,
no doubt, a little greater, and the ascent somewhat steep, but the
beautiful house is at the top, with the pure air of heaven instead
of an atmosphere which no amount of carbolic or chlorine can
render wholesome.

Let any one who doubts walk up University street to the site
where the foundation is now being dug, and as he stands there
let him note how his chest expands and he draws full and
gratifying inspirations of pure air free from dust, disease germs,
and the exhalations from yards and refuse heaps. Let him
imagine a palace for the sick erected there—roomy, clean and
airy, with fine surrounding grounds, provided with all that
modern science can secure in the way of both sunitary and
sanatory conditions, he will return thankful and content, and will
be prepared to attach as much value to the learned prognostica-

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tions of evil which have haunted the Royal Victoria Hospital as
to the caw of’ the crow which flies acr2ss his path.

This is a part of one side of the question, but the venerable and
honored General Hospital has something to say for itself and its
site which should also be listened to.

THe OLp Hospi. SITE.

To the Editor of Tax GAzErte :

Siz,—In a previous communication something was said as to
the advantages of the site of the Royal Victoria Hospital. Let
us now turn to the old site, as it muy be supposed to appear to
the ordinary citizen.

The venerable and justly loved. and respected (reneral Hospital
has, beyond the remembrance of the present generation of men,
been an institution of which our city has good reason to be proud,
and which has conferred inestimable benefits not only on our
own citizens but also upon strangers. It has been emphatically
the English hospital, managed on the principles which commend
themselves to the practical good sense and sagacity of the Eng-
lish-speaking portion of our people, attracting to itself the best
medical talent of Canada, and cared for and supported by the élite
of our citizens, while it has extended its benefits to patients of
every origin and creed. It has also been an essential helper to
the great medical school which has given Montreal celebrity as
a centre of professional education, as well as to the rivals which
have recently endeavored to share its laurels, It has now the
prestige of great reputation and enduring usefulness. Its present
governors revere it as an object of solicitude to good men who
have passed away, and generations of our citizens have looked to
it as their resource in accident or sickness.

Such an institution necessarily commends itself to the good
will of all men, and it has accordingly from time to time received
many generous gifts, and few of our more wealthy citizens de-
part this life without remembering it in their .vills, while there
is no charity to which they are more willing to contribute. Any
attempt to weaken or injure it would be sure to meet with public
reprobation.

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The site of the General hospital was selected at s time when
the city of Montreal was almost limited to the ridge occupied by
St. James and Notre Dame streets, when Craig street was in great
part a swamp where a botanist might still collect marsh plants
and where possibly an early sportsman might chance to have a
a shot atasnipe. Dorchester street was then nearly as far afield
as the mountain park is now; and if the records of the time were
carefully searched, it would no doubt be found that there were
conservative people then who deprecated a location so distant
from the heart of the city, and contrasted it with that of the
older hospitals then near the river side. Medical doctors at that
time considered the central part of St. James Street sufficiently
remote from their patients, and probably regarded a drive to
Dorchester strvet as something of the nature of a country visit.
Since that time all the large populations occupying the western
and upper parts of the city have grown up, and the General
hospital is nearer to the river than to the rear of the city, while the
part of the town surrounding it is becoming more and more occu-
pied with shops, warehouses and factories, and it is being more
and more enveloped in the increasing smoke of a manufacturing
town.

The nuns in the meantime have wisely removed their great
hospital to the upper part of the city, where it has ample spuce for
extension, and for surrounding grounds, and where the existence
of the park on its western side, that of the prevailing wind, ensures
to it for all time the inestimable blessing of fresh air for its
patients. In these ways it possesses inducements which com-
mend themselves to the people, and which tend to counterbalance
the great advantages in other respects offered by the General
hospital. The latter also falls short of the accommodation neces.
sary to meet the present demand. It is said that many patients
have to be refused admission, and that the space both for patients
and attendants is altogether inadequate. Donations and bequests
in aid of extension, it is true, huve been received, and plans for
improved buildings have been prepared, but the more prudent
and sagacious of the governors unquestionably are impressed with
the feeling that it would be improvilent to expend large sums of
money on a site at present insufficient for the requirements of a
good modern hospital, and which must yearly become, with the

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extension of the city and the occupation of its central part for
business purposes, more and more unsuitable. The governors of
the hospital should, in the public interest, regard not the present
merely, but the future, and note the upward and westward ex-
tension of trade, population, and our churches and public insti-
tutions. They should also bear in mind that within not many
years the churches and public institutions, which are now moving
up to western Dorchester and St. Catherine streets, will be as
much “down town” as they were in St. James and Craig streets,
and the time is coming when the Mountain park will be in the
middle of the city. They should be prepared not to tie them-
selves to a piece of ground, however hallowed by old association,
but should be ready to act with the same wise forethought which
animated the original founders of the hospital, at a time whon
the present extension of Montreal would have been regarded as
an impossibility.

In the circumstances, the foundation of the Royal Victoria
hospital on a site further removed from the lower and less salu-
brious portion of the city, should be regarded by those interested
in’ the General hospital as a welcome deliverance from a great
and increasing difficulty ; and if any arrangement can be secured
whereby the two hospitals can work together and be mutually
helpful, a great advantage to the public will be secured. Besides
this, economy is «n important object. So long as our French-
Canadian fellow-citizens prefer the ecclesiastically managed hos-
pitals, which are now being so severely repressed by their bre-
thren beyond the sea, it is evident that the support and manage-
ment of properly equipped general hospitals :.. 1st devolve on the
comparatively small English element, and this should not be
burdened with a duplication of work and expense. It follows
that amalgamation of some kind must commend itself’ to all pru-
dent men, animated by a sincere regard for the public welfare;
and the question really is how this may best be effected. To this
end some concessions may be required in matters non-essential,
while securing the permanence of a thoroughly efficiont manag-
ing board representing all interests, and the retention of all that
is desirable in the capabilities of both sites and of the buildings
erected upon them.

Fortunately, while there is some natural hesitation and indis-

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position to any precipitate action on the part of the governors of
the General hospital, the majority of them are disposed fairly to
weigh in the public interest any proposals laid before them ; and
the board of the Victoria hospital, on its part, has made advances
and offered large concessions in aid of union. This, it is under-
stood, is with the full concurrence of the generous founders of
the new hospital; who by the purchase of enlarged space on the
mountain side, at a great additional cost, have shown themselves
disposed to consult in every way, even the prejudices of some of the
citizens, while at the same time advancing much beyond our old
ideas of the requirements of a great and growing city, of whose
extension and prosperity in the future they have, from their own
successful work in this direction, some reason to feel confident,
When the agitation for the improvement of the parish schools of
Scotland was in progress some years ago, an attempt was made
to raise a popular cry to the effect that this was derogatory to
the memory of Knox, the great founder of these schvols. The
reply was: “If Knox had been of your mind, there would have
been neither reformation nor parish schools.” Let us not allow
unreasonable prepossessions with reference to the past to stand
in the way of enlightened provision for the future. This, how-
ever, raises the question, how best the rival sites may be combined
and used for the public benefit ; and this may afford material for
another communication.

Merits AND Uses oF THE Two SITEs.
To the Editor of the Gazette:

Sir,—If the facts and inferences stated in my previous letters
have commended themselves to the good sense of those inter-
ested in the matter, the next question will be how, in view of
these facts, we may best use the two sites now available in the
interest of the public. The alternatives are: (1.) There may
be two distinct hospitals, duplicating each other’s work, and
rivals for public support. (2.) The two hospitals may remain
distinct, but with some alliance of a more or less intimate char-
acter, providing for common action in certain matters. (3.)
There may be a complete amalgamation under a united board of

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management, and with a single purse. The first of these is obvi-
ously likely to lead to much inconvenience and waste, while it
wiil emphasize that disunion of which our groups of churches
on Beaver Hall, St. Catherine street, and around the Windsor
Hotel, are at present outward manifestations in the religious
world, but which, happily, has as yet had small effect on our
charitable and educational institutions. The second mode would
be cumbrous and uncertain in its working, and, therefore, pro-
bably inefficient, while it might not be free from the rivalries
and jealousies incident to separate managements. If the hospi-
tals were purely business corporations, like banks or insurance
companies, we might hope that in either of the above modes
some healthy competition would arise beneficial to the public,
but, unfortunately, this law of competition does not hold in ben-
evolent enterprises in the same way as in those that are merely
commercial. The third mode, that of amalgamation, therefore,
remains as the most desirable if it can be attained.

To secure a united board, two concessions, one on the part of
the Victoria Hospital and one on that of the General, seem neces-
sary. The former must consent to enlarge its board of manage-
ment so as to admit of an adequate representation of the latter,
and must modify somewhat its conditions for the admission of
life associates. The latter must come under the management of
a united board on which its numerous governors wil! act not
directly but through representatives. There would seem to be
little difference of opinion as to the expediency of these conces-
sions, the principai question raised being as to the : mount of
representation of each hospital in the first instance. It has
been proposed to adjust this on the basis of a representation in
proportion to the amount of property and income possessed by
each hospital, which seems a not unfair arrangement. 1t is to
be observed, however, that any difficulty on this point applies
merely to the board as at first constituted, while the hospitals
are yet separate. When once united, as their constituencies, or
the great majority of them, consist of the same persons, no ques-
tion can arise as to the one hospital as distinct from the other.
The whole wil! then be one establishment, with two piaces for
carrying on its business.

But then arises the question as to the business to be carried on

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in each place. This must finally be a question for the united
board, and any attempt to tie up its hands for all time would
certainly be injurious. But some arrangement should be made
for the initial distribution in a way that might remain undis-
turbed, so long as the present condition of the city and ite
hospital requirements continues.

Here common sense would dictate that, as the higher site is the
more salubrious, and has the advantage of a change of air to a
higher atmospheric stratum, it is best suited to continued and
chronic cases and to convalescents, whether recovering from
disease or from surgical operations. On the other hand, the
lower site is more accessible to out-door patients from all the
central and eastern parts of the city, and is raore convenient for
cases of accident and emergency. These considerations might
easily form a basis for a primary division of work. The ordinary
cases may be removed from the General to the Victoria, so soon
as it can be ready, and the dispensary rooms, the arrangements
for cases of accident and the accommodation for patients of that
kind in the General may be improved'and enlarged, so soun as it
can be freed from the burden of the ordinary patients.. In this
way nothing of consequence would be duplicated, there would be
an intelligible division of work, and the public would have a
vastly better provision for its needs than at present. The
question of contagious diseases, which practically should have a
distinct provision amounting to a third hospital building, might
be left for final decision to the united board, though the higher,
more distant and more salubrious site should be secured for it if
means will permit.

It may be objected that by this arrangement the function of
the General hospital will be too much diminished, This, however,
is a short-sighted view. The accommodation for dispensary ser-
vice needs great enlargement and improvement, and is in any case
a large, important and increasing department. The increase of
the city and the growth of its factories and its shipping will
unhappily rapidly augment the number of accidents, and im-
proved provision for the immediate and effectual treatment of
these would tend to determine them more and more to the hos-
pital. It is not improbable that the provision of fifty beds, which
has been estimated for this service, might, in a few years, have

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to be increased by the united board to an hundred, while the beds
in the Victoria hospital may be fully occupied. Another and
most important consideration is that in both hospitals there
would be an absence of that overcrowding and insufficiency of
room and appliance which affects the General hospital at present.
With ample space and improved means, the physicians, surgeons,
nurses, and patients, would all be in more favorable conditions,
and better results in every respect might be anticipated. In a
growing city like Montreal all public institutions are more or less
afflicted with a chronic insufficiency of means to meet the
demands made upon them, and it is much to be desired that this
should once for all be effectually cured in the case of our
hospitals.

The writer of these letters makes no pretension to gifts of pro-
phecy; but he can infer as to the future from what he has seen
in the past. If the present opportunity is lost, it may pass away
for ever, and those who, from the best intentions, obstruct a |
wholesome union, may live to regret their present action. The
old hospital, with all its past prestige and popularity, will neces-
sarily suffer most from a failure to unite. It is the law of our
time that the new must increase, the old decrease. The General
hospital may decay and fall into inferior hands, while the Vic-
toria may find itself hampered and overburdened. It is to be
hoped, however, that this failure will not occur, and that as a
United General Victoria hospital, or perhaps in honor of the
Queen it should be “Victoria General,” the combined institutions
will enter on a new and magnificent career of usefulness. In any
case let us not incur the risk of being blamed by those who suc-
ceed us for throwing away, even in part, the benefits of one of
the noblest benefactions of our time.

ON-LOOKER.

July 27, 1889.

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EpIroRIAL COMMENTS.

The attention of our readers has, doubtless, been directed to
the letters of our correspondent on “ Hospital Sites,” which ap-
peared in our issues of the 16th, 24th and 31st ult. The writer
of those letters has pleaded with such convictiun and convincing-
ness for the consolidation of the General and the Victoria
hospitals into one strong, serviceable institution, with its build-
ings on a site where the blessing of pure air might be had con-
stantly and in abundance, that all reasonable people must
acknowledge the force of his argument. Touching the union of
the two institutions he puts the alternative succinctly and clearly
before the public—“two distinct hospitals, duplicating each
other’s work, and rivals for public support.’’ And of this alter-
native he says that it “is obviously likely to lead to much in-
convenience and waste.” Granting, then, that on the ground of
correct business principles and common sense, the preference
must be given to the plan of united action, on what terms should
the two institutions agree to co-operate? “ Onlooker” suggests
two methods as possible. By one of these the two hospitals may
remain distinct, but with some alliance of a more or less intimate
character, providing for common action in certain matters, The
alternative to this arrangement is “ complete amalgamation under
a united board of management and with a single purse.” The
former of these two schemes of union our correspondent char-
acterizes as ‘“ cumbrous and uncertain in its workings, und, there-
fore, probably inefficient, while it might not be free from the
rivalries and jealousies incident to separate managements.” In
fact, for the purposes of unted action it would be found inade-
quate, and in practice would be disappointing. ‘There remains
the plan of complete amalgamation, and the first question to be
answered is whether it can be effected. Our correspondent thinks
that it can—the concessions necessary to that end being, on the
part of the Victoria Hospital, an enlargement of its board and a
modification of its terms of admitting life associates ; and, on the
part of the General Hospital, the consent of its Governors to a
representative, instead of a direct control in the united board.
The representation, it was suggested, should be adjusted on the

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basis of each hospital’s property and income; but as the result of
the meetings of the committees, it is believed the Governors of
the Victoria have consented that, all the present Governors of the
General shall be continued as associate Governors of the new
institution, and that the qualifications for future Governors shall
be lowered. Should these propositions be accepted we shall
have one great hospital with two centres for conducting its
operations. :

How, then, should the work be didided between the old city
and the new suburban or extramural establishment. Our cor-
respondent devotes two of his letters to a consideration of the
respective merits of the Dorchester street and the mountain site,
Those who have read his comments must admit that his contrast
between the air of the lower and that of the upper portion of the
city is not a whit too emphatic. Solvitur ambulando, as our cor-
respondent, with his twofold experience, suggests. To expend
money on rebuilding on a site because it was chosen some seventy
years ago by men whom all must revere, would be imitation in
letter but not in spirit. Look at a picture of the General Hospital
in ita early years! It is in the fields, Between it and Craig
street are men harvesting their grain. There is not a house in
the neighborhood of it save its own outbuildings. Beyond, to-
wards Sherbrooke street, are villas, surrounded by orchards and
groves, It isa rural scene throughout, 'The grounds had been
known as Marshall’s Nursery before they were purchased by the
Hon. Messrs. Richardson and McGillivray and Mr, Samuel Ger-
rard, Every word that “Onlooker”’ has written on the choice
of a site for a new hospital bears the impress of sound sense and
merits the sanction of the hygienic expert. Wherever just such
warnings as he utters have been disregarded, the consequence has
been disastrous, On this point one of the greatest of modern
authorities thus expresses himself :—‘ Fresh and pure air being
a prime necessity, as well as a considerable amount of space of
actual area in proportion to population, it would certainly appear
to be better to place hospitals as much in the outskirts as is con-
sistent with considerations of usefulness and convenience. In
short, the best site would be in the fields; but, if that be im-
practicable, a large space—a sanitary zone—should be kept per-
manently free between the hospital and the surrounding build-

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ings.” The same writer says that, in most cases, it would be
advantageous to dispose of the present buildings and sites of city
hospitals and to retain only a receiving house in their stead.

Now this is jnst the view taken by our correspondent, He
would keep the lower site (the General Hospital) for out-door
patients and cases of accident and emergency as well as
(with needed improvements) for a dispensary. The hospital
occupying the higher and more salubrious ground would then be
set apart for chronic cases and convalescents, As to the sufferers
from contagious diseases, who would require isolation and the
purest air available—the question of providing for them might
be left to the consideration of the united board.

Such, in the brief outline, is our correspondent’s plan for the
solution of a problem of the highest interest to our city. That
there may be objections to it, he is aware. Of these, the most
weighty is that which touches the prestige, integrity and inde-
pendence of that time-honored institution—the General Hospital.
There is really, however, no conflict of interests. Those who
are concerted for the welfare of the old are alike concerned for
the future of the new hospital. Both have been created for the
same benevolent objects—for the relief of the same classes of
sufferers and in the service of the same community. It is essential,
therefore, for the highest efficiency, contemplated by the
founders of each of them, that they work together and not apart,
without, however, any sacrifice of the name and fame of the older
nstitution.